Provider Demographics
NPI:1538189394
Name:TANDY, CHRISTINE ALICE (LPC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ALICE
Last Name:TANDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 SE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1310
Mailing Address - Country:US
Mailing Address - Phone:503-866-3479
Mailing Address - Fax:503-232-3484
Practice Address - Street 1:12 SE 14TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1404
Practice Address - Country:US
Practice Address - Phone:503-866-3479
Practice Address - Fax:503-232-3484
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1568101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional